Early inflammatory bowel disease: different treatment response to specific or all medications?

BACKGROUND

The literature suggests that medications prescribed for the treatment of inflammatory bowel disease may be more efficacious in children than adults. Care must be exercised in comparing these data, however, as significant differences in disease duration and concomitant therapy are present among studies.

METHODS

Review of key clinical trials, meta-analyses and observational registries for which there are treatment response data from both pediatric and adult Crohn's disease (CD) populations.

RESULTS

Acute response to corticosteroids is similar in children (84-89%) and adults (80-84%), but prolonged response may be better in children (50-61 vs. 32-44%). Differences in duration of CD among the various studies' subjects and the proportion of subjects receiving concomitant immunomodulators probably explain much of these differences. CD remission rates with thiopurines appear higher in children at both 6 months (85 vs. 31%) and 15-18 months (81 vs. 42%), but the reported outcomes are likely influenced by very short duration of CD in the pediatric populations studied. Similarly, remission of CD 1 year following initiation of infliximab also appears higher in children (56%) than adults (28%), but again differences in study populations' durations of CD and use of concomitant immunomodulators likely are responsible for the observed differences.

CONCLUSION

Differences between pediatric and adult responses to a variety of IBD treatments appear to be due more to study design than the age of the subjects evaluated. As published pediatric trials have generally evaluated subjects with potent treatments at or shortly after diagnosis, the consistently higher rates of responses seen in children lend weight to the argument that some form of 'top-down' therapy offers the best option to maximize remission rates in all patients with IBD.